Not as discussed as the Mandate, but also under consideration by the Supremes is the provision of ACA that expands Medicaid eligibility under age 65. The States’ position is this is a “coercive” expansion. The politics is that the provision is anti-Federalist, forcing the states to spend as wildly as the Feds. Well, the Feds may very well be spending wildly. But it’s pretty hard to say that they’re dragging the states down with them on this issue.